Transcript
Michael Suelmann (00:00) hello? Angie.
Angie L (00:03) Oh, I was muted. Hi.
Michael Suelmann (00:07) Looks like you’re on a spaceship.
Angie L (00:09) Yeah. I was looking at all the different backgrounds and one of them was this and I was like that’s quite cool. It’s better than a blur.
Michael Suelmann (00:18) Okay. Well, I should officially change mine. Let’s.
Angie L (00:22) see, they also have the golden gate bridge, which I almost did because we visited there in November and then they have grass.
Michael Suelmann (00:33) Let’s make this official. Can you see me? Yep? Okay.
Angie L (00:46) I don’t know why I scheduled this late in the afternoon for us on a Friday. All of us are brain dead at this point.
Michael Suelmann (01:33) I have someone joining from medallion, and do you have any others, that are joining today?
Angie L (01:42) We have one more, but you can get started.
Michael Suelmann (01:44) Okay. Let’s give it a couple minutes.
Colleen Croghan (01:54) I like your background Eugene.
Angie L (01:57) It was either this or the blur and I thought, hey, let’s do this Friday.
Michael Suelmann (02:02) Let’s make this exciting. Let’s go out with a bang. Yeah.
Michael Suelmann (02:13) Let me check on. Scott will be joining.
Scott Everline (02:23) Hello? Happy Friday.
Colleen Croghan (02:25) Hello?
Michael Suelmann (02:28) Hey, Scott and Mike.
Michael Suelmann (02:35) We were just amazed by Angie’s background. I.
Scott Everline (02:42) mean, you have the super slick medallion background. I need to get out the program. I just got like some cheap image of a Monet in the background, but you’re yeah, that works. Yeah, but Angie, I like it.
Angie L (02:53) I can do this one.
Scott Everline (02:55) Slip into San Francisco.
Angie L (02:55) I can do this one… but this one’s cooler.
Scott Everline (03:00) Yeah, it’s way cooler teams has got some cool ones that like sparkle in the background and they have like the northern lights waving in the background. It’s amazing. My adhd doesn’t like it, but it’s pretty cool to see on a screen.
Angie L (03:16) Trechell and I have the beach behind us and then our other person, Lori, she has the mountains behind her.
Scott Everline (03:23) Nice. Well, that could be natural, right? Mountains behind you guys.
Angie L (03:29) Well, I’m in Florida, and so is Lori, I’m in?
Colleen Croghan (03:34) The mountains? Okay?
Scott Everline (03:38) I’m jealous shall.
Michael Suelmann (03:40) We do some brief introductions before we get into the demo. Do you want to take a couple seconds? Sure. I’ll start Mike sulman, I’m… vice president of enterprise sales. I live in st Louis and I just joined medallion two weeks ago, very excited. Nice. Very excited to be here. Scott. Have you met the crew before? I?
Scott Everline (04:11) Think all of us were on the first call together but hello, all again. Happy Friday. So, I’m the solution consultant here at medallion kind of will run us through a more payer enrollment focused demonstration today, really digging into the weeds and answer your questions and help you understand how the medallion system works.
Colleen Croghan (04:34) Thanks, Scott. Happy to have you on the call because we were super excited with your caqh background for sure. I’m Colleen krogan, I’m the system director of revenue cycle here at bozeman health.
Angie L (04:49) I’m Angie, I’m the payer enrollment supervisor, and I’m really excited to see this today because we were really impressed with just the brief part that we saw. So, and the caqh is a definite bonus.
Colleen Croghan (05:04) Yeah, I’m trechell, Schroeder. Hi, everyone. I’m on the payer enrollment team. Angie, did you say we were waiting for one more or is this it?
Angie L (05:18) I was waiting for Lori, but we can get started. She just showed.
Michael Suelmann (05:23) up. Let me admit her. Oh, there she is okay. Very good. Hello, Lori.
Angie L (05:36) Hi, sorry.
Michael Suelmann (05:42) All right. I think we have a full team here and looking forward to Scott walking you through medallion and focusing on payer enrollment. Scott. Any words that you have before we get started?
Scott Everline (06:00) No, I mean, I think we like ideally, we kind of have a very interactive conversation about what the system does and make sure you all feel comfortable with it. Hopefully you built enough comfort and trust with me when we met last time, right? And happy to go into any rabbit holes. You all want to go into. My caqh consultation fees are 350 dollars an hour. But I do free advising when I’m here on behalf of medallion. So happy to answer any questions in that direction as well. All jokes aside. I don’t do any caqh consulting but I feel like that could be a full time job for somebody because it’s a real thing. Yeah. So if you all are good, I’ll jump into the platform and I know we have 55 minutes. So that’s time to answer all your questions. And, you know, if I’m going through anything too quickly too slowly shout… at me right? As a refresher from last time we met, you know, medallion’s focus is really around kind of creating an enterprise solution that services multiple entities within an organization. And a lot of that’s going to start with the provider experience, right? Whether that’s their interaction with the platform or ideally a limited interaction with the platform, right? So making sure that we have a meaningful onboarding workflow that supports a provider’s ability to do what they’re in the world to do, which is to see patients if you all want. I’m happy to run back through kind of the onboarding process or if you all want to just dive right into kind of what the payer enrollment workflow looks like. I’m happy to do that too. It’s kind of a choose your own adventure here.
Angie L (07:45) We don’t do, my team doesn’t do the onboarding at all. We only do the payer enrollment. So when you do your call with Jesse, that’ll be the onboarding and credentialing. We’re very separated. So we’re just interested in the payer enrollment piece and the re, attestations and things like that.
Scott Everline (08:00) Okay. Awesome. Let me pull up a provider profile… just so you all can get a little bit of flavor of how we approach some of the payer… enrollment processing. So your credentialing team, medallion… has done a really good job capturing all the necessary information from a provider. Of course, I grabbed a provider that didn’t have an enrollment. It’s too Naomi because I know she has some… what we do and I have to share kind of like what’s on the back end because we have plenty of time to do it. But essentially, we have this intake process, right? So what we do is we look at all these various payer enrollment requests. So whether that’s you know, a direct payer enrollment, whether it’s credentialing request, might be delegated agreements. If we’re looking at supporting delegated rosters and looking at those elements. But then we’re also looking at privileging which this account isn’t set up for. But essentially what we’re doing is we’re looking at those various requirements for all of those tasks, right? So we’re looking across the breadth of those tasks by payer, by line of business, by provider type. And then within the platform, we are triggering notifications back. And this is a terrible example because this provider has done everything we want them to do. But you can see we’re essentially tracking based on those requests and the requirements affiliated with them. We are then identifying where the gaps exist within that provider profile, whether that’s documentation, whether that’s dates, whether that’s licenses, whatever it might be. And then tasking that information back. So when you think about how organizations use AI, medallion’s very thoughtful in our approach. And this is one of the places where AI has really been able to enable us to kind of do this review process without somebody having to memorize all of the individual payer enrollment requests and go through this process manually. So this intake process will capture any of these gaps, task them back to the provider. So you’ll see there’s information that might be missing. It could be taxed back to the administrators. So if you have, you know, a perspective of, we want any issues, any tasks to come back through the admin team, and then we will triage directly with the providers. We are indifferent to that. However you all want that communication plan set up, right? So notifying you notifying the providers. Hey, there’s missing information based on the enrollments that we have in flight. So I’ll get too heavily into the tasking if you want to see like the payer directory on. The back end where kind of all those rules and requirements are listed, happy to jump into it. Just know that, that’s kind of what the system is feeding off of, right? And we essentially a, because of the volume of enrollments we submit to payers, but also B, because we have an entire team dedicated to just doing that payer enrollment research, the team, the system identify when there’s gaps. So if we submit an enrollment, it comes back with an error. Our goal is to have a sub one percent and we’re you know, one to two percent resubmission rate, but we want to have a sub one percent resubmission rate that’s only going to be achieved if we’re continuously looking and evaluating and again using automations where we can to identify when there are gaps even in the way we process an enrollment. So that thing gets captured. And then that back end system essentially gets reset. So this payer enrollment section or payer directories you can see has almost 1,200 requirements for payers across the country, by service, type, by line of business, based on specific markets, etc. And so that is really what’s the engine driving. I say, encyclopedia britannica, right of payer enrollment. So that’s really the engine that’s driving that intake process to make sure that we’re not missing any components and get the right enrollment out the door the first time. Any questions, comments on that?
Scott Everline (12:10) I don’t have any.
Scott Everline (12:16) Four enrollments themselves. Kind of curious. Like do you all, would you envision yourselves initiating enrollments through like an upstream system? Like if say, when a provider finishes credentialing, you would want to kick off an enrollment. But I’d imagine credentialing enrollment run in parallel. So then is it like you hire a new provider and your HRIS system wants to kick off a new enrollment? Or would you all want to have control over how that enrollment gets initiated, being coming into a platform or like loading a new file for net new providers?
Angie L (12:53) We’re typically the ones that… because of our insurances, a few of them require rosters, a few of them require applications. Some of them are online, you know, with care, there’s payco. So we typically, as soon as we get notification that a provider needs to be pay or enrolled in addition to credential, that we would be the ones that would kind of initiate, you know, if we get five providers all starting on eight, one, 60 days before we put them on the roster. And, okay, and you have to upload it to blue cross. So it’ll be us that, probably at least starts all of the enrollments. Okay, great.
Scott Everline (13:40) So, think about how that would work from a medallion perspective, right? Some, probably some changes to your process today, but you do have that control over, you know, there’s a new pay or enrollment. Maybe it’s a demographic update, maybe it’s a bulk demographic update, right? Like you’re adding a provider to an existing contract or getting that information fed over to the payer, we’ll essentially capture the full list of your payers that you work with. You’ll be able to see kind of in real time what requests are out, which files are, which requests are being processed, which need attention completed, and it gets more granular. I promise, it doesn’t just stop at this org level. But to submit that request within the platform, you’re going to identify whether it’s a, an enrollment, for a group, an org, a provider or a facility. Do you all do any facility enrollments? Yes. Okay. Net, new facilities or maintaining existing facilities?
Angie L (14:40) Both. We just recently, created a rural health center. Okay? So we had to go through adding that to our big skyton, which again we had, I had to track it on smartsheets and excel and fun stuff. All that fun stuff because it had, it has its own mpi. But then we also have, our big sky facility that we maintain and our deaconess, and it would be helpful to be able to go in and say, when we think our next, re, cred could potentially be because we do take care of the re, credentialing of, the groups that’s us, not the medical staff office, definitely.
Scott Everline (15:23) Okay. And when you say re, credentialing, it’s more around like the revalidation process yeah, which includes credentialing but like there’s a, yeah. Okay. Okay. So within the request, right? You’re going to select multi, select providers. So you’re going to have the providers in the system, you’ll get that notification. Hey, there’s five new providers that need to be added. The systems are going to have a conniption fit with me doing this.
Angie L (15:47) At least we’re all.
Scott Everline (15:47) In the same group. So then I’m going to have, you know, we’ll have your groups loaded in the platform. So you’ll be able to affiliate that provider with one or more groups.
Angie L (15:57) See.
Scott Everline (15:59) And this, I knew it was going to have a fit. So, this is telling me that two of these groups, right? So there’s, some algorithmic catches here to make sure that, you know, two of these providers aren’t added to the group. So, what will happen is, if I move forward, I’ll get a notice that those two providers will actually in the system be added to the group, right? If not, I need to pull the two providers out of this request.
Scott Everline (16:21) I’m then going to select a state. This case. Again, it’s not actually going to allow me to gather a state.
Angie L (16:28) Because the.
Scott Everline (16:28) providers aren’t licensed and collectively in the same state. So, every one of these providers, they don’t have any overlapping states. So we’re going to reduce some of this noise real quick just so we can see what a happy path looks like. All right. So, dr early has a license in multiple states. It’s going to compare the location with the state data. And then I’m going to be able to select a payer. This will be truncated down with your payer list. There’s always the ability to add more payers but you’re able to come into the platform and grab that, right? If the… group isn’t enrolled, it’ll actually identify that a group enrollment is required. And then I’m going to be able to affiliate through the practice locations. So I can just say, you know, this will automatically select the appropriate locations affiliated with the group that apply to that contract.
Angie L (17:27) So, you’ll see.
Scott Everline (17:28) It kind of pre populated these groups. And then I can say whether or not I want to use the same practice for all locations. And then I’m going to kind of directory questions, right? Provider needs to be published in the directory, any desired effective dates you’ll see the defaults here. And then any additional notes that I want to put into the platform, I’ll be able to do that. So, Angie when you talked about like rosters, portal platforms, payers, paper forms, right? This is where the system on the backend is aware of all those requirements and we will then take the data out of the provider profile, populate that form of submission, right? So whether it’s us literally web crawling out to a website via bots to feed data into like an availability platform, whether it’s populating a payer enrollment template. So we have our own template agreements with kind of 40 of your largest payers in the country. So we’re able to do kind of bulk submissions through templates.
Angie L (18:27) Or,
Scott Everline (18:28) whether it’s literally, we need to fill out a PDF because that’s how the payer does it, right? We populate that PDF web form. And then we submit that through I’m, not going to hit submit because my payer enrollment team gets grumpy with me when I do. But essentially, what happens is then that process kicks off, right? So the intake process will capture those requirements by payer, manage that tasking, making sure that you as well as the providers are aware as to what information is necessary to complete those enrollments, and then your team will have access to all.
Angie L (19:02) Of.
Scott Everline (19:02) the visibility of what happens through the rest of that process, right? So you’ll see all of enrollments. You can narrow it down to just ones that have been requested. Perhaps, you know, we have contractual guarantees around when we will deliver these things, right? So we.
Angie L (19:16) can look.
Scott Everline (19:17) At, you know, is this thing running behind providers have the exact same view here. So if I go in as a provider, I can see my own version of where all of my enrollments are. So whether they’re requested, I can check which ones are processing. I can check and see which enrollments might need my attention. So there might be enrollments that are in flight that… have a dependency that I need to address or something along those lines. And then we’ll follow those files all the way through to the completed status. And then we will notify yourselves… as well as the providers potentially API reports out to other downstream teams, other systems, right? Customers that want that information fed to like a scheduling software, right? Because that scheduling software now needs to know that provider is eligible to see patients from specific payers, we can feed that information into those downstream systems so that other stakeholders have that info.
Angie L (20:14) All the.
Scott Everline (20:15) outreach, all those communications will be a visible kind of.
Angie L (20:18) kind of not kind.
Scott Everline (20:20) Of throughout that entire journey, right? And then we have AI agents that do the phone call follow ups which are pretty cool. So they do, they can navigate payr ivr systems to make sure that they’re getting the right information. We also do direct portal linkages. So we’ll go to like availity and check on status or payr portals to check on status of enrollments and then feed that information back into the platform.
Scott Everline (20:49) Pause because that’s a lot.
Angie L (20:51) Any questions? Yeah. It sounds like this… potentially does everything that we’re doing because we make sure that, you know, like we log into medicaid and we have to link the providers or sometimes we have to unlink the providers? So, are you saying that if, once the provider fills out their information, if they’re considered payr, you’re going to send out information to all the different payrs because that.
Angie L (21:24) Sounds… it’s too good to be true in a sense. And also, I don’t know, I guess I have control issues, I think so different.
Scott Everline (21:37) Run across, Angie.
Angie L (21:40) Yeah. So.
Scott Everline (21:41) I will say we do, I will not say we get 100 percent of it done. There’s always going to be gaps… in the process that we communicate back to you all. But that triage that evaluation even down to like the management of getting data into a portal or into a forum medallion is taking that process on and that’s vastly automation with some humans in the loop just to make sure that we’re validating and catching any gaps or bugs that you know, the technology can’t support. So it definitely frees your team up of kind of managing or tracking, you know, the if this then that on the payer enrollment forms, and then just literally logging into all these portals and managing that information. We also reconcile data with caqh. So we’ll feed like if we have group data and it’s not on the caqh profile, we’ll actually map that directly to the provider’s caqh profile to make sure that’s updated. So that doesn’t cause any delays. But you’re still going to have control as to who’s being submitted for what payer… and really have a little bit more time on your hands, ideally to do more meaningful work than filling out a PDF form the system’s generating that.
Angie L (23:01) I definitely do not enjoy good. Okay. But we’re… typically the ones that send… the… forms or email them to the reps. Yep, but I’m just trying to figure out like our entire workflow and completely.
Scott Everline (23:24) Change. Yeah. So like if it would be helpful to do like a high level, what you would be doing, what medallion, what the platform and, you know, the services would be doing. Ultimately, you all would be initiating the requests to medallion, supporting any gaps within the provider data. So the tasking that takes place, right? Whether we task it back to your team, whether we task it back to the provider, kind of managing that data acquisition process for anybody or any gaps that are in the information. And then essentially, when the information comes back, if there’s any again information that needs to be managed throughout the submission process, we would work with you all to facilitate the collection of that… and then updating teams reporting et cetera on kind of the status of providers, existing enrollments versus enrollments that are in flight and et cetera. That meaty middle, that administrative dare I curse and say, pain in the ass middle that very few people find joy in that’s where our robots seem to enjoy that. And then we have of course, people in the process to kind of again to kind of overlap that overlay that, and then conduct some quality control type measures.
Angie L (24:44) And is this automation and background running? Is that included in the price or is that something where, you can either use it as like a payer enrollment database or you can have the work done behind the screen? Is it, all, is this is included in? Does that make sense?
Scott Everline (25:02) It does. Yeah, it’s a question we get a lot. So it is like a fully baked in model. Okay. So there’s not. So there’s not like a self service module where you can use the medallion tooling tracking and then do that generation piece. There’s no uncoupling the two components.
Colleen Croghan (25:26) Scott, I’m glad you brought that term robot up. Can you, I know I don’t have the RFP in front of me but can you at a high level talk about where AI comes to play in the use of your platform?
Scott Everline (25:42) Yeah. So, I’d say that the core places are during that intake process, right? So triaging enrollment requests to what is leveraged within… payor requirements with the payor enrollment requests or credentialing requests, right? So, AI is orchestrating some of that work on the back end. So really making sure that we’re directing things through the right funnels at the right time in the process. So like we, I mean, we literally use the term orchestration. It is an orchestration engine on the back end, right? And so it’s moving things through the journey in a right way. We use… OCR which some people would consider AI. So image capturing. So the ability to extract data from documents that are uploaded. So like if you load your Coi, right? The provider’s not going to have to log into medallion or somebody’s not going to have to log in and transpose that data into the profile. The system will use OCR. I would argue from a nerd’s perspective that’s not actually AI, but that is automation, right? So that’s going to bring the data directly off of that form into the profile. And then the submission process, I… would say for payer enrollment is not necessarily AI, but there is automation to be able to feed that in. So that’s again me being a little semantical about what we call AI. But there is automation typically that’s process automation where we’re web crawling into systems and delivering data onto portals like availity. And then the other big AI true AI lever is around the follow ups, right? So that’s the automated phone call follow ups. And if we want, we can get on a call and I can literally have it call one of your cell phones and you’ll get the whole script and it’ll walk us through. It’s. Actually kind of cool because you can even ask it questions on the topic that it’s calling you about. You can even ask it who caqh is, which is kind of an interesting response. But so those AI agents are the ones that are doing that follow up. So we don’t necessarily have a phone bank of people following up with the payers and tracking that. And then same thing when it comes to the… follow up within the platforms, right? That’s a combination of AI as well as again that process automation where we’re screen scraping information from the system.
Colleen Croghan (28:04) Okay. Thank you.
Scott Everline (28:05) Yeah, I.
Colleen Croghan (28:06) Have to get into deeper into that if we move forward with.
Scott Everline (28:09) Our it group but sure. Yeah, we’re used to it. Yeah, I bet, yeah, I mean, I will say like my, at least my opinion on two pieces around the AI model is like one, we’re not dealing with patient data, which is great because that makes it teams a lot more manageable. Sure. And then the other piece is like we aren’t really using it to… like manipulate the data per SE. It’s really like navigating through some of this process and making sure that things are moving in a direction that don’t get hung up in like a human based bottleneck. So not a lot of risks exactly. Yeah, I mean, we’ve been really thoughtful and like you will run into other vendors that will come out of the gates and be like everything is AI. And, I don’t know if they’re fooling themselves or if they think the market isn’t very intelligent because that’s impossible, right? There is no way that we can leverage AI to completely automate this entire ecosystem that we have. And so, our process is very intentional. We find new ways to leverage AI. So, like I was out, we were in Texas this past week with like, the whole sales team except for Mike for whatever, and he had better things to do than hang out in Texas and honky tonk with us. But we were sitting down with a new person from the product team and the system anonymously captures every click that happens in the platform. So not the data but like what people’s mice, mouse clicks are doing within the platform that then gets leveraged through AI and the systems continuously looking at, hey, like people get stuck on this page a lot, right? People are clicking on this button over and over again. And maybe the screen takes a little bit longer to load. Speaking of load. So, the, that’s another way on the backend that we’re leveraging AI to just evaluate system functionality and user experience. Like when we record phone calls, we use an AI tool that will aggregate the phone call and tell us and we can go back and review it. It can prepare notes for the next call, all that fun stuff. But from a system perspective that’s kind of sorry, I went off on an AI rant, but like on the system perspective, it’s primarily around that orchestration of tasks. And then the follow up piece today. Okay?
Angie L (30:34) Thank you for.
Scott Everline (30:35) That, yeah.
Angie L (30:39) Anything else? Yeah. Sorry, is that how you’re able to do the re, attestations for the providers as well? Are.
Scott Everline (30:46) you within caqh? Attestations?
Angie L (30:48) Yeah.
Scott Everline (30:50) So, no… I think we all wish caqh had a way that would allow us to do re attestations through AI. Caqh doesn’t have any inbound consumption model. It’s automated. So we use RPA, so process automation. So it’s basically like a scripted web crawl that goes into caqh, grabs the provider credentials, goes into the system, takes the data from medallion, feeds that into the caqh profile, and then follows through to the attestation button. Caqh hasn’t built like a meaningful inbound API tooling today… the pro view for groups thing, provider data for groups or whatever. And then we leverage that and that pushes like core group information like group practice, location, group, affiliated details. But like when it comes to like licensure management and updating board certs, and Dea, and all that stuff that goes through RPA modeling. We have a video if you want that shows kind of how like the system’s directly mapping that data from medallion into caqh. So.
Michael Suelmann (32:06) Being new to medallion but not new to credentialing and payer, enrollment, the… ability to have medallion as a source of truth for caqh. As well as the other thing I wanted to mention was the rules engine behind the scenes. But by payer, and the rules around each payer, by type of provider that’s huge that’s.
Scott Everline (32:34) huge. Yeah, definitely. That’s a good call. Yeah. I mean, I think like historically like today on the bozeman team, like how do you all keep track of all that? Is that just within people’s brains because you have a high level of expertise and staffing that is aware of it or is there some… platform functionality that supports that today?
Angie L (32:58) For caqh, we just get the emails that come in and then we go in and do the re, attestation, but we have, you know, when the provider first comes on board, they sign something that states… that they will do the attest that they agree to the attestation questions. But then just recently, we had, you know, after 10 years, a malpractice can be removed and we have had a payer reach out and was like, this provider has needs this question updated and we were like, what are you talking about? So then we had to like dig in and they’re like you just need to remove it and we were just like, why does it matter if I feel like it should be an option to remove it? But if we leave it on there, why are you giving us an issue, right? But it’s mainly, we just use the incoming emails to track those things. And for the new providers, some of them don’t even have caqh. They haven’t never had to create a profile. So we’ll go in and create the profile and then have them sign off on their attestations. But that requires us going in and, you know, putting all of their education and things like that, which it’s fine. It’s not, it happens very, not… very often watch. I just jinxed this but.
Scott Everline (34:26) The whole slew of new grads… yeah, it’s funny. The comment about the, so you’re talking about the disclosure questions, I’m assuming like the never have I ever questions of like have you have an email practice suits? Have you lost your license? Have you lost privileges?
Angie L (34:42) Yeah, do you do jobs?
Scott Everline (34:46) Yeah. It’s interesting that a pair would come back like you would just ignore it if it was 10 years old. Yeah, it’s like if it’s an mpdb hit that’s 10 years old, it’s not like you go back and you’re like, oh, we got to take the provider to committee. Like if it’s a 10 year old mpdb hit, you’re probably just going to ignore it and it’s not going to hit your committee. It’s considered clean.
Angie L (35:06) And it was closed. That’s why when I wrote back to them, I’m like his attestations, I sent him a copy of the whole protocol. I’m like his attestation is correct. And he goes well, the malpractice is prior to it’s and it was 12 years old. So this provider had had it there for two years and now all of a sudden they’re like, no, you can take it out, yeah, or you have to take it out. I’m like this is nuts. I feel like I feel like.
Scott Everline (35:37) I can say this because I’ve worked for payers in the past but it feels like it’s just a payer being a payer and I hate saying that… like even here literally says past 10 years. Yeah, right. So, like, anyway, so there are like we do have that caqh management piece where we can manage the attestation cycle and we will map the data from here into that provider profile. So for those net new providers, you know, do you have them come into medallion and load it? Do you go to caqh? And then we import it from caqh? And it’s just a matter of which process makes the most amount of sense. But it is kind of that we’ll call it a bi directional feed, knowing that some of it is like process automation that needs to go into caqh. We do get those signatures here within the platform too, right? So we’ll get the agreement to update data for caqh. So we’ll get the profile authorization, so we can contact caqh on behalf of the provider that all gets signed within the medallion platform. So that if we need to again call the help desk for some reason, we’re authorized to be able to do that.
Colleen Croghan (36:48) And that’s not additional that’s within the regular functionality that we would be signing.
Scott Everline (36:55) up for. So it’s a, it is a SKU, like it is a service line that medallion offers there’s like a per provider per year fee for that. Okay? I don’t know. I don’t recall if Scott included that in any pricing… we can confirm that and get it back.
Colleen Croghan (37:14) To you? Okay. Yeah, that’s that’d be great. Scott, the one question I have and we kind of touched on it. I think last time we met, but I think because Angie and her team do so much manual work right now in spreadsheets, can you talk to us about going live and what does that mean to get us fully functioning within medallion? And what does that lift on the bozeman health operational team?
Scott Everline (37:40) Yep. If you can believe it, we’ve actually had to do this before with other customers. We have as… part of the onboarding team, we have these roles at medallion called technical solution managers or tsms. For short, they get assigned to the implementation and they’re all but engineers. So they’re there is an import template that we leverage. I can share it with you. All it’s essentially has kind of all of your core fields that we would need and the tsms work closely with you. We even have a tool that basically says like here’s what you fed over. And then here’s errors on the data that you sent over, right? Because like one of the things we come across is like payer, name discrepancies, right? You might call blue cross blue shield of Montana something, and we might have blue cross blue shield of MT, right? And that’ll cause because data is data, it’ll throw it off. So we have translation tools that the tsms will leverage to support kind of all that data migration and mapping. It sounds like you would be taking data from potentially multiple spreadsheets, getting that into the medallion template. Do you do anything in a system today? Like is there I forget if you’re leveraging like a healthstream or… we have Arl, datix, okay. That’s right?
Angie L (39:11) And I think that’s why I’m kind of in like a little shell stock because right now we’re doing so much like we, I have to anything I pull from verge, I have to manipulate it in some way. I can’t pull a roster to send to first choice or blue cross. I can’t pull a full roster because it has a ton of the placeholders in it. And I try to explain to them. If you have one placeholder in there, then I have to manually manipulate it. So this is taking us from having to do almost everything manually to not really having to do anything at all. And that’s I think that’s a, that’s an extreme for us for what we’re doing right now not to have some type of control over, you know, when do these things go out? Because they’ll… they’ve notified us of providers that are starting in September already. Well, obviously, we don’t want to start that enrollment piece until 60.
Scott Everline (40:16) Days prior, sure.
Angie L (40:18) So, I think… confusion or my thing is, what is it that we’re going to need to do other than fill in gaps? What is it that… we’re going to need to do other than fill in gaps? We have some providers. Sorry, my brain’s everywhere. We have some providers that do not go through credentialing at all. They do not go through the medical staff office because they’re auxiliary providers, but they do have to be pay enrolled. So we have a payer enrollment only category… and we would need to send those out to the payers and get certain signatures. But… if we’re able to do that and not have them go through the credentialing process as well. Is that possible?
Scott Everline (41:10) Oh, absolutely. Yeah. So the two processes are able to run distinct. They’re set up and they do run distinct within medallion. So you could submit a provider through payer enrollment or credentialing because I’d imagine there’s going to be providers that go through privileging that don’t that you all don’t do enrollment for, right? So, like on the other side of the coin, it’s going to be a similar situation where the one team isn’t doing what your team does, right?
Scott Everline (41:37) There’s a beautiful world where the two align. So, it would so like even going back to your, the first one, right? Where you’re like provider started in December, but we don’t want to enroll them for another 90 or until they’re 60 days out. That’s what you have absolute total control over, right? You’re managing that. We don’t we’re not going to auto send a request unless we talk about like… in detail what an auto submission would look like and what the timing needs to look like for that. And that’s what your TSM as well would do, right? And that really works if there’s an upstream system. So if like there’s an HRS system, theoretically, right? And I would have to have like the head of our TSM team in, to talk about it. But like theoretically, if it’s coming out of your HR system and it says provider is contracted, but they don’t start until June… the TSM should be able to take that start date, count back 60 days and then initiate that process. But it doesn’t have to, right? If it’s still your team kind of managing that onboarding process or managing that request of like, hey, here’s, a new provider. They’re going to start in June. You can start kind of doing that math and then you just submit that through what medallion is really ultimately doing is filling out the paperwork based on the profile and then pushing that over to the payer. And then just knocking on the door every week or two to check on the status until it’s completed. But like the initiation of it, where it goes after it’s been completed, what other systems it needs to feed into you kind of have guidance and direction around that, and how much of that is automated is up to you all. But kind of all that stuff in the middle where it’s like filling out the fields and making sure that you’re attaching the right documents with each individual payer’s, enrollment request and loading it to the platform. All that stuff is what medallion’s kind of owning… does that help Angie? I think so. Okay.
Angie L (43:30) With your… no, go ahead Colleen.
Colleen Croghan (43:34) I was just going to ask, it… may be in the RFP again. I just don’t have it pulled up. But what is the onboarding? What’s the timeline to onboard us?
Scott Everline (43:48) If we’re talking just PE… eight to 12 weeks depends on what the status of your data is, that’s usually the longest poll in the tent is the date like the status of your existing data to get that into medallion.
Scott Everline (44:08) It can take anywhere from two weeks to six to eight weeks depending on how messy it is and how much data transformation needs to be done. And then the rest of it’s like getting your payers loaded, which doesn’t take any time at all. And then for net new providers, there’s really just the time it takes them to kind of get moving with privileging it might take a little bit longer just because we’re building out dop forms and building all those like unique facility specific credentialing requirements. Those two things can run in parallel, but they privileging can take a little bit longer depending on how complicated your credentialing process is and how many forms we have to load and how many facilities and committees and all that stuff we need to set up.
Colleen Croghan (44:52) And we recommend we go in parallel or what would it be more beneficial to do one before the other one?
Scott Everline (45:04) I’m going to give you a very consultant based answer and say it depends.
Colleen Croghan (45:07) Okay. Sorry on your data or?
Scott Everline (45:12) Yeah. I mean, I think it depends on what your prioritization is and where your biggest pain point is… not speaking for medallion. So Mike plug your ears and go off camera. So I don’t have to watch you gasp speaking for medallion. It would be a lot to bite off in one fell swoop… because I’m thinking, you know, like if I were just thinking like you, right? Like that’s a lot to take on and like for all two teams at the same time could be challenging.
Colleen Croghan (45:42) Well, and our biggest pain point is payer enrollment and we don’t know on the mso side, you know, what their contract looks like with verge, you know? So we may end up taking payer enrollment online first and then do mso or privileging later.
Scott Everline (46:01) If I had to pick one of those two to start with, I would agree with you on the payer enrollment side… I’ll say our product knowing I worked for aural datix for a spell, post… verge, just post verge, their credentialing tooling is not as good as medallion’s but it’s better than their payer enrollment tooling. And our payer enrollment tooling is light years ahead of where verge is from. A or aural datix is from a payer enrollment perspective. Yeah, I think your bang for your buck is going to be much better if you, and just like think about the financial consequences of like PE delays and headaches versus credentialing delays and headaches like… a lot more money like more Roi on a PE change because you’re also going to like start talking about reducing turnaround times, right? And getting staff focused on, potentially other things. And yeah, so I think there’s definitely more to gain from the PE shift being first. And then it makes the shift over to the credentialing privileging side, the mso team, a little bit easier, right? Because a lot of the groundwork the foundation is already there.
Michael Suelmann (47:12) Got it. Close my ears. So they’re open now. Yeah. You know, what I have seen constantly… is that silos, in health systems, medical staff, RCM pay enrollment teams with silos, there’s definitely a benefit, to streamline process between the two disciplines. The, the overall benefit is that you… plus the medical staff team, it.
Scott Everline (47:45) It’s.
Michael Suelmann (47:45) integrated and it becomes seamless at some point.
Scott Everline (47:49) So that, that’s the.
Michael Suelmann (47:50) ultimate benefit of a completely integrated platform like medallion.
Scott Everline (47:57) It almost feels.
Colleen Croghan (47:58) like and correct me if I’m wrong, Scott and Mike, but it almost feels like going with PE first will improve our efficiencies in our process. But then bringing the mso on and being integrated will be that optimization.
Scott Everline (48:13) Yeah, I.
Michael Suelmann (48:14) would agree.
Scott Everline (48:15) Yep. But.
Angie L (48:17) If we do pay our enrollment first, we’re going to, we would have to upload via their caqh information because they’re not going to be onboarding through here and we don’t typically go to our providers for multiple things. We don’t want to keep bugging them. So, is that when we would just use their caqa information to pull in or can it be fixed with Rl datix? Or how would that work?
Scott Everline (48:49) Yeah. So it could be like if so onboarding today is in Rl, datix.
Angie L (48:57) Well, I don’t honestly, I don’t know what they do when I first came on board and realized the functionality of the payr piece of it. And.
Lori Eckard (49:10) granted.
Angie L (49:11) Bozeman was a beta tester, but we’ve been a beta tester the entire one and a half years. I’ve been here. They have never had something that just works, you know, like we.
Lori Eckard (49:24) I.
Angie L (49:25) don’t I don’t mind downloading a pre populated form and emailing it. None of that. It’s, when.
Lori Eckard (49:33) it pulls the wrong.
Angie L (49:34) Data and they’ll be like, oh, we had an update and you need to change this filter and just, they’re so clunky and the payr enrollment piece of it is just so it was like, hey, we’re going to create this tab and we’re going to throw some stuff on here, but all of it’s going to be the credentialing information. So, if the provider ends up having their credentialing is kind of put off because they’re waiting for something, we don’t stop like they can work in our clinic and not work in our hospital with credentials, you know, or with privileges. But if.
Lori Eckard (50:07) they change the initial.
Angie L (50:09) Start date… is our start date and we’re like, no, the provider’s starting at this clinic regardless of if they go to committee or not. So, it’s just been very, it’s… very difficult. It breaks all the time. It doesn’t.
Lori Eckard (50:27) I mean right now,
Angie L (50:29) instead of the N backslash a, they’re doing N forward slash a, and I have to go in and fix it because I’m just like, and I’ve told them about this twice and I know it seems so small, but I have been fighting and arguing with them for over a year and a half and they’ll say, oh, no, we got you a roster nope you have not. So I’m.
Lori Eckard (50:54) just, I would not, we don’t.
Angie L (50:56) have a source of truth right now. Unfortunately, I was just been recently comparing our bozeman website versus verge versus what’s on my roster.
Lori Eckard (51:08) I have,
Angie L (51:10) very few that actually match. So, unfortunately… verge only has that one primary address in it.
Lori Eckard (51:20) And if they work at other.
Angie L (51:21) Locations, it’s not going to show.
Lori Eckard (51:24) So, they.
Scott Everline (51:25) don’t store it or it doesn’t show like it doesn’t get.
Angie L (51:28) Fed out, it doesn’t show, they have it broken out.
Lori Eckard (51:33) Into our.
Angie L (51:35) two tax ids.
Lori Eckard (51:37) But even when.
Angie L (51:38) we have four tax ids. They had it in two tax ids in.
Lori Eckard (51:44) Two groups.
Angie L (51:45) They had big sky and they had deaconess, but.
Scott Everline (51:48) I’d imagine it would be problematic when you’re doing enrollments too if it’s feeding that same logic.
Angie L (51:55) Well, we did ask them to build like a tertiary or a secondary tertiary, that kind of form. So, if we pick secondary, it’ll pick the secondary location we added. But even now that we’ve done these locations, some of these providers have gone from this pediatric location to this pediatric location, and I can’t go in and just change the address.
Lori Eckard (52:22) I have.
Angie L (52:23) To add the address, update, it all, change it all to enrolled. I have to manually do it.
Lori Eckard (52:30) And we don’t necessarily.
Angie L (52:32) Need to manually enroll them if it’s under the same tin. Does?
Scott Everline (52:37) That make sense? Yep. It’s more of like, hey, this new.
Angie L (52:41) Provider’s over here. Yeah. And it’s just.
Lori Eckard (52:45) Been… the only way we.
Angie L (52:48) Can get to work is our enrollment statuses. You know, I can get them, but I still have to manipulate the excel sheet because we do give that out to everyone in the company.
Lori Eckard (52:58) So, if they.
Angie L (52:59) Have a question about if a provider is enrolled in progress or then we put that out there for them. So they know without having to email us.
Colleen Croghan (53:09) That’s a good point. Angie, is there that kind of report, Scott that we can generate out of medallion to share instead of manually doing an in progress or status report for our organization?
Scott Everline (53:22) Yeah. So we have like a pre built dashboard that’s an enrollment report that.
Lori Eckard (53:31) Gives you kind.
Scott Everline (53:32) Of status by provider, by type, by state kind of business. So, like all open enrollments, you can see providers count by enrollment type.
Scott Everline (53:50) We can also like if it’s just like even just thinking about going to like this page… and looking at existing enrollments, right?
Lori Eckard (54:02) So, this is.
Scott Everline (54:03) Going to be all the existing enrollments. So, after.
Lori Eckard (54:06) everything’s been.
Scott Everline (54:07) Processed your current status of enrollments, and we would map this in for historical would be here within the platform. So you can see which are active which are inactive. You can see what practice location, so, if there’s more than one practice location, it’s here within the platform, you can literally just download that directly from here.
Lori Eckard (54:29) But what we could also do is just,
Scott Everline (54:31) like talk to the TSM and the TSM will structure an API call, not that you all have to do the call, but they’ll structure an API call and deliver a report. So, we have lots of customer that will have report needs like that. And then we’ll build out a dashboard that you can either self service within the platform or we can just email you weekly the report, right? The cool thing is if it’s a dashboard, it can get refreshed essentially in real time and then you can generate that dashboard because any of the dashboard reports you can download. So if I want to download it into excel file because that’s the format, we like fine, download it into an excel format and all the data that feeds into that dashboard will show up.
Angie L (55:14) If I need to run a report that’ll say, you know, like the providers mpi, first name, last name, the location, and then a list of the insurances, and if they’re enrolled or not enrolled.
Lori Eckard (55:27) Yeah, pay enrollment status. Yep. So you can do.
Scott Everline (55:32) Payor lines of business provider mpi?
Lori Eckard (55:37) If you wanted.
Scott Everline (55:38) Specialty, you could do specialty facility?
Lori Eckard (55:44) Practices.
Scott Everline (55:44) and I would just create this custom report ad hoc and it would give me what I’m looking for… this report and we’d run it. I just did like a really basic one but you can see there’s a lot of stuff in here.
Angie L (55:56) Do they have the status?
Scott Everline (55:59) I think this is just where’s status. It’s going to be in here. Why am I searching? I should be smarter than that.
Lori Eckard (56:07) Status. Yeah.
Lori Eckard (56:15) Yeah. So it’s not going to.
Angie L (56:17) Tell us if it’s in progress or if it’s if they’re.
Scott Everline (56:20) complete. Well, it says completed.
Lori Eckard (56:24) And then anything that’s not.
Scott Everline (56:25) Completed is going to be like requested. We haven’t started working on it assigned someone’s working on it application submitted means that it’s in the hands of the payer, we’re waiting for the payer response and then completed is a completed one.
Angie L (56:38) Okay. So that is technically we could download that. And then we can manipulate the status to say, if it’s completed, then that means they’re enrolled. And then everything else we would change to in progress because the people that are viewing this, some of them are customer service reps that are getting complaints that are saying this provider isn’t in network and we’re like, well, yes, they are, they were enrolled on this date.
Scott Everline (57:05) Yeah. So you could, I mean, you could very easily turn it into like a vlookup binary table if you wanted to. We could also again, like if what I think would be interesting is like let’s just pull an example of a dream report, like take.
Lori Eckard (57:22) Like.
Scott Everline (57:22) An excel file and put together what you want or even I could put together a cell file and just treat it like walk through it and then just put that in the hands of our TSM and be like, can you build this report for me?
Lori Eckard (57:34) And I would say eight.
Scott Everline (57:35) Out of 10 times they’re going to say yes, and then we might charge for the report depending on how complicated it is. But it doesn’t sound like what you’re asking for is all that different from what a lot of our payr enrollment customers ask for.
Lori Eckard (57:48) Yeah, it’s.
Angie L (57:50) just something that we started to supply that anyone that’s within bozeman can view it because we don’t want them to have insight here. You know, we don’t want them to be able to log in. It’s just, but we also don’t want them emailing us every week asking us for a status on a particular payr.
Scott Everline (58:10) So, yeah. And same thing with privileging, right? Like if you’re talking about within the hospital, right? Joint commission requires like.
Lori Eckard (58:18) Privileging status.
Scott Everline (58:19) To be confirmed and fed so that anybody in the hospital?
Lori Eckard (58:24) Or the facility?
Scott Everline (58:25) Can report on that. So similar concept, right? I would just define what frequency we want that delivered, whether it’s something you self service, or whether you just give us the parameters and we deliver it.
Lori Eckard (58:38) I have another question I wanted.
Colleen Croghan (58:39) To clarify what you said earlier about Angie’s comment about getting a provider that may not be starting until September. Can you tee that up in the system so that the process starts X amount of days before their start date. So we don’t have to handle it anymore. We can just enter it and trust the process will start at that timeframe.
Scott Everline (59:05) I’d have to talk to product, I’ll make a note of that and see if that’s something we could create.
Lori Eckard (59:13) There’s not like.
Scott Everline (59:14) When I submit an enrollment request, there’s not like a start date that I put in here.
Lori Eckard (59:23) We could.
Scott Everline (59:23) Potentially like within the provider profile, there is a start date.
Lori Eckard (59:34) So, we could potentially let me talk to some folks because.
Scott Everline (59:38) It might be something we would be able to use this start date. So, like when they’re getting loaded, you guys are assigning their right start date. So it’s not the day they’ve requested or the day they’re added, right? This is their start date and we could potentially use that to initiate or pen to the request until that start date hits, but I would have to talk to product.
Lori Eckard (59:58) Or.
Scott Everline (59:58) Engineering team to see if that’s something we could do.
Colleen Croghan (60:00) Okay. And then my last question, I know we’re running out of time, but I believe the RFP said that you would provide references upon request. Could we check out a few references and see how they like the product?
Scott Everline (60:13) Yep, definitely. Yeah. So Michael will chase them down for you.
Colleen Croghan (60:16) Awesome. Thank you, Angie. How about you and your team? Do you have any other questions?
Angie L (60:21) I have one more quick question. How do you guys handle the Ina surrogacy request because that’s something that is definitely… like we have to go into our Ina and request that the providers give us a surrogacy, so we can reassign benefits on their behalf. Is that something we would still do? Or is that something that you, that is done in the background?
Scott Everline (60:47) You’re talking about Pecos?
Angie L (60:48) Yes. Okay. Yeah, Ina, for the provider, we do everything in Pecos, but.
Scott Everline (60:54) Okay. Yeah. So we do it. I don’t know the exact specifics, but I can get somebody from our payer enrollment team to kind of spell out what that looks like and shoot you guys back the response, but we do manage that process, right? So the request gets sent and we can manage that because we do the Pecos enrollments and revalidations for customers all the time.
Colleen Croghan (61:17) Anything else before we end, Angie or anybody else? Trechell looks like you came off mute. Did you have a question? No, I think that was answered?
Lori Eckard (61:30) Well, this was good to.
Colleen Croghan (61:32) Continue talking about the product if we could get references and then maybe some follow up to a couple questions. And then I know the mso is having, I think another demo on the 20 first that’s right? And then we’ll convene and see what our decision is.
Scott Everline (61:51) Okay. So the two questions I have outside of references is like, is there a way to trigger an enrollment request based on the start date? And?
Lori Eckard (61:59) The other one is just like.
Scott Everline (62:00) A detailed explanation as to how we handle the surrogacy piece?
Lori Eckard (62:04) Anything else? Yeah, Angie, did you want?
Colleen Croghan (62:06) The mapping of the caqh that he mentioned early on or is that not necessary? No, I.
Angie L (62:14) don’t think I need to see the background of… that, okay?
Scott Everline (62:19) Super.
Angie L (62:20) fun to watch, Angie. You can send it.
Scott Everline (62:23) And when I need, it’s like a video that one of our engineers produced and it just shows, oh,
Colleen Croghan (62:29) it’s a video.
Scott Everline (62:30) Yeah, it’s literally like just a like of like us feeding and writing data into caqh and clicking next.
Angie L (62:37) Yeah. Go ahead and send it.
Scott Everline (62:39) Faster fingers than any of ours. Yeah, I’ll grab that.
Colleen Croghan (62:42) Awesome. Thank you for your time today and we’ll be in touch.
Angie L (62:47) Thank you, everybody.
Colleen Croghan (62:48) Nice to meet everybody. Nice to meet you. Bye bye.